Excellent survival and low complication rate in medium-term follow-up after arterial switch operation for complete transposition

Abstract

Objective: To determine medium-term outcome after arterial switch operation for complete transposition in a population-based cohort.

Design: Retrospective study of all 86 patients operated on at our institution from 1982 to 2000. Age at operation was 0-256 days (median 6 days); 28 (32%) had closure of a ventricular septal defect, 2 of whom had double outlet right ventricle. Additional surgery included coarctectomy in three, pulmonary artery banding in two and atrial septectomy in one patient.

Results: Thirty-day operative mortality was 7/86 (8.1%), after 1988 mortality was only 3.8% and confined to patients with unusual coronary artery patterns. There was no late mortality; Kaplan-Meier survival was 91%. Five patients (6% of survivors) were reoperated for right ventricular outflow tract obstruction. At last follow-up, 86% were free from complications; three had neurological complications, two were on treatment for ventricular dysfunction and one had a pacemaker for postoperative atrioventricular block.

Conclusion: In this cohort of first-generation patients treated with arterial switch operation, medium-term survival is excellent and the rate of reoperation and sequelae is low.